- Depersonalization: description
- Depersonalization: symptoms
- Depersonalization: causes and risk factors
- Depersonalization: examinations and diagnosis
- Depersonalization: treatment
- Depersonalization: Disease course and prognosis
A depersonalization is a mental state of emergency. People who suffer from it look at their life from the outside, like a movie. The own body, their feelings but also other people and objects are alien to them. The origin of the separation of themselves and the environment often lies in previous traumatic experiences. Read all important information about depersonalization and derealization here.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. F42F48
Marian Grosser, Doctor
In a depersonalization sufferers have the feeling to look at themselves from the outside. However, they are always aware that their perceptions deceive them - an important difference to psychosis.
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Depersonalization describes an alienation from one's own person. Those affected have a disturbed self-perception and feel detached from their ego. In a derealization, on the other hand, those affected feel that their environment is not real. Depersonalization and derealization often occur together and are therefore referred to as depersonalization and derealization syndrome or summarized by the term depersonalization.
Almost every person in life experiences such symptoms in a weak form and for a limited time. Depersonalization disorder, however, means that sufferers suffer from episodes over a long period of time or recurrently.
Depersonalization is a disorder that has been poorly researched so far. In many cases it is overlooked. Sometimes she hides behind another mental disorder, sometimes the dreamer does not dare to go to the doctor with these symptoms because they are afraid that he will not take them seriously or thinks they are crazy.
Depersonalization: who is affected?
It is estimated that about one to three percent of the population is affected by a depersonalization disorder. Very often it appears as a symptom of other mental disorders. These include depression, phobic disorders, obsessive-compulsive disorder and borderline disorder. As an independent disorder, it is often diagnosed in adolescence. In their study of students in Rhineland-Palatinate, researchers from the University of Mainz Clinic came to the conclusion that 12 percent of students experience depersonalisation symptoms. Depersonalisation syndrome occurs approximately equally in men and women.
Depersonalization and derealization can occur in different degrees of severity. A mild form of depersonalization can also be observed in everyday life when people are under extreme stress or after alcohol abuse. However, the altered perception of fatigue is short-lived and need not be addressed.
Reduced pain perception
Life-threatening situations that put the body under severe stress can trigger longer-lasting depersonalization symptoms. In psychologically stressful or painful situations, depersonalization reduces pain perception. It is thus a protective mechanism of the psyche from strongly unpleasant sensations.
Alienation and unreal reality
If the symptoms persist for several years or reoccur again and again, it is a mental disorder. The main characteristics of depersonalization are the feeling of alienation regarding one's own person and the perceived unreality of reality. Those affected no longer know who they are. Some do not recognize themselves in the mirror. Your body is detached from them. This condition is also described as a feeling of lifelessness. When people feel inwardly split into one part that acts and one who watches, experts talk about an out-of-body experience.
Often, sufferers not only take themselves but also their environment changed. This perception is so unreal that people find it difficult to put it into words. Often they describe their vision as blurry or as in a dream. People can be lifeless, objects can be perceived larger or smaller, and noises can be heard distorted.
In activities, they do not perceive themselves as executing persons. Their actions are true, but it is as if they are standing next to each other and watching each other. Since the affected have no inner relation to their actions, they feel that they are foreign and automated.
Depersonalization is often associated with a sense of inner emptiness. Persons affected by emotional events do not react. They show neither joy, sadness nor anger.They are therefore often cool and absent. These symptoms are very similar to those of a depressive mood and are not easily distinguished. Depersonalization can also appear as a symptom of depression. Conversely, depression may also occur as a result of depersonalisation symptoms.
People who have had traumatic experiences often no longer or only partially remember these experiences. Depersonalization then serves as a shield and does not allow negative memories to enter consciousness. Stress quickly causes memory problems. Events can often not be timed by those affected, because their perception of time is distorted.
Unlike people with psychosis, people with depersonalization syndrome know that their altered perception is due to their condition. People with psychotic states, on the other hand, are convinced that their view of the world is real. For example, they believe that other people can manipulate their thoughts and feelings. People with depersonalization symptoms realize that not the world has changed, but something is wrong with their perception. This knowledge increases the suffering and frightens those affected.
Pondering and fears
The fear of going crazy is a frequent consequence of depersonalization and derealization. Symptoms of detachment from oneself and the environment deeply unsettle people. Likewise, fears, compulsions, and depression are often associated with depersonalization. Many speak out of fear of not being taken seriously, not about their problems.
Depersonalization: causes and risk factors
The emergence of depersonalization and derealization lead experts back to the interaction of various factors. It is thought that the predisposition affects whether the mental disorder occurs or not. So far, there is no evidence for a hereditary component.
Experts believe that people with heightened anxiety are more susceptible to depersonalization and derealization. Causes are, as with many mental disorders, often found in childhood and adolescence. Stress and traumatic experiences are the most common triggers of depersonalization.
Direct trigger of depersonalization
As a concrete trigger of depersonalization, stress plays a central role. In particular, traumatic experiences can trigger depersonalization. Severe illnesses, accidents or even professional and violent interpersonal crises can be the beginning of depersonalization. In unbearable situations, it can happen that people inwardly move away from themselves and the event. Experts believe that this reaction is a protective mechanism when other coping strategies are insufficient. The affected are then only physically present, but in their thoughts, they are not present. Depersonalization is often described as rest after the storm. Only when the stress decreases, the symptoms of depersonalization appear.
Researchers have found that, above all, emotional neglect in childhood favors depersonalization. These sufferers have received too little attention from their parents, have been humiliated or not perceived. The lack of support from the social environment can create unfavorable coping strategies. Thus, even in childhood first symptoms of alienation of themselves and the environment can occur. The severity of depersonalization depends on the intensity and duration of negative experiences.
Risk factor lifestyle
People who neglect their physical and mental health may experience depersonalisation symptoms. In addition, depersonalization may be the result of illicit drug use or alcohol poisoning. Insufficient sleep and lack of fluid may also cause symptoms of depersonalization or increase existing symptoms.
Depersonalization: examinations and diagnosis
As the first contact, you can contact your family doctor. He will perform a physical examination if suspected Depersonalisationssyndrom. Because the depersonalization can also occur as a result of physical disorders, such as epilepsy or migraine. The doctor must also rule out that the symptoms occur as a side effect of drugs or as a result of withdrawal. Even drugs can create feelings of alienation. For the exact diagnosis and the treatment the family doctor transfers to specialists.
To diagnose depersonalization, a psychiatrist or psychotherapist conducts a detailed conversation with the patient. Using clinical questionnaires, the doctor or therapist can determine if it is indeed a depersonalization or if there are other mental disorders.
The following questions could ask the doctor or therapist to diagnose Depersonalisationsstörung:
- Do you sometimes feel like you are a stranger to yourself?
- Do you sometimes have the impression of looking at yourself from the outside?
- Does your environment sometimes seem unreal?
- Do you sometimes feel that other people or objects are not real?
According to the International Classification of Mental Disorders (ICD-10), at least either depersonalization or derealization must be present for the diagnosis of depersonalization and derealization syndrome:
- Depersonalization syndrome: The affected feel their feelings and experiences as foreign to them, seem detached, removed, lost or seem to belong to someone else. They also complain of the feeling of "not being right here".
- or that
- Derealization Syndrome: Those affected perceive their environment, objects or other people as unreal, distant, artificial, colorless or lifeless.
In addition, those affected must be aware that the changed perception is not generated from the outside, but springs from their thoughts.
The research of depersonalization and derealisation is still in its infancy. There is a lack of studies on the effectiveness of therapies and medications. Drugs are therefore not yet approved for the therapy of depersonalization. Healing in the sense of total freedom from symptoms is most likely to occur with weak depersonalization. In severe cases, the goal is to alleviate the symptoms or shorten the phases during which depersonalization occurs. The method of choice for treatment is psychotherapy.
At the beginning of the therapy, the therapist explains the patient in detail about the mental disorder (psychoeducation). The sufferer experiences that his suffering is taken seriously and his distorted perception is not a sign of "madness" but part of a disease. The patient learns to question negative and catastrophizing thoughts and to replace them with realistic assessments. An important goal of the therapy is to reduce fears and thus relieve the person psychologically.
Stress management and coping strategies
Another building block in therapy is dealing with stress. In many patients, stress leads to depersonalisation symptoms. They leave their bodies and move away from their environment and problems. This process will automatically stop after some time. Using a journal, the patient should note which situations trigger the symptoms of depersonalization. This overview helps the sufferer to better recognize patterns and processes of the disease.
Together with the therapist, patients work out different strategies to deal with difficult situations. The affected person must learn to avoid frightening situations. If the person is confident in other coping strategies, they no longer need to distance themselves or the situation. A change in lifestyle can contribute to recovery. Insufficient sleep, nutrition and lack of hydration increase the symptoms.
If symptoms of alienation occur, for example, biting into a chili pod or clapping loudly can help to get back to reality. A helpful method can also be distraction. Conversations or sports activities should turn the thoughts into reality. Distraction also prevents fears from swinging upwards. Through these and other strategies, patients learn to control the depersonalization symptoms.
Relaxation exercises are not recommended for depersonalization because too much rest can cause the symptoms. Soothing activities, such as walking, are more suitable for rest.
Dealing with the causes
In many cases, traumatic experiences are the cause of depersonalization. To treat trauma, the patient should first have learned how to deal with the symptoms. It is also important that the affected person can perceive, express and control his emotions. Only after the stabilization phase can a conflict with traumatic causes take place.
Depersonalization: Disease course and prognosis
The first Depersonalisationssymptome usually show up in adolescence or even in childhood. The onset in late adulthood is very rare and strengthens the suspicion of an organic cause. Depersonalization can occur both chronically and in episodes. The course depends on the one hand, when the depersonalization has begun and on the other, whether it is adequately treated. The earlier the mental disorder occurs, the worse the prognosis. No treatment requires a mild form of depersonalization and derealization. Healing occurs in this case after a short time by itself.
If the symptoms are pronounced, those affected usually suffer for a long time from symptoms of depersonalization and derealization. But with the help of psychotherapy, they can learn to better control the symptoms. In addition, sufferers can favorably influence the course by reducing stress. Under psychological stress, on the other hand, the symptoms of the disease become worse depersonalization still.